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Research ArticleOriginal Research

Diagnostic Errors in Primary Care: Lessons Learned

John W. Ely, Lauris C. Kaldjian and Donna M. D'Alessandro
The Journal of the American Board of Family Medicine January 2012, 25 (1) 87-97; DOI: https://doi.org/10.3122/jabfm.2012.01.110174
John W. Ely
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Lauris C. Kaldjian
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Donna M. D'Alessandro
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Abstract

Background: Diagnostic errors occur more commonly than other kinds of errors, they are more likely to harm patients, and they are more likely to be preventable. Little is known about the presenting complaints, initial (incorrect) diagnoses, and physicians' personal lessons learned related to diagnostic errors.

Methods: In 2009 and 2010, we invited a random sample of 200 family physicians, 200 general internists, and 200 general pediatricians practicing in Iowa to describe an important diagnostic error using a 1-page, mailed questionnaire. The data were analyzed using quantitative and qualitative methods.

Results: The response rate was 34% (202 of 600 physicians). Common presenting complaints included abdominal pain (n = 27 of 202 patients, 13%); fever (n = 19; 9%); and fatigue (n = 15, 7%). Common initial (incorrect) diagnoses included benign viral infections (n = 35, 17%); musculoskeletal pain (n = 21, 10%); and chronic obstructive pulmonary disease/asthma (n = 13, 6%). The 202 responding physicians described 254 personal lessons learned, which we used to develop a taxonomy of 24 generic lessons. Three common lessons were: (1) consider diagnosis X in patients presenting with symptom Y (n = 37 lessons, 15%; eg, “Any discomfort above the umbilicus may be coronary artery disease.”); (2) look beyond the initial, most obvious diagnosis (n = 26 lessons, 10%); and (3) be alert to atypical presentations of disease (n = 24 lessons, 9%).

Conclusions: In this study, diagnostic errors often were preceded by common symptoms and common, relatively benign initial diagnoses. The lessons learned often involved various aspects of broadening the differential diagnosis.

  • Decision Making
  • Diagnostic Errors
  • Primary Health Care
  • Quality of Health Care
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The Journal of the American Board of Family     Medicine: 25 (1)
The Journal of the American Board of Family Medicine
Vol. 25, Issue 1
January-February 2012
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Diagnostic Errors in Primary Care: Lessons Learned
John W. Ely, Lauris C. Kaldjian, Donna M. D'Alessandro
The Journal of the American Board of Family Medicine Jan 2012, 25 (1) 87-97; DOI: 10.3122/jabfm.2012.01.110174

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Diagnostic Errors in Primary Care: Lessons Learned
John W. Ely, Lauris C. Kaldjian, Donna M. D'Alessandro
The Journal of the American Board of Family Medicine Jan 2012, 25 (1) 87-97; DOI: 10.3122/jabfm.2012.01.110174
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    • Appendix 1: Physician Questionnaire
    • Appendix 2: Taxonomy of Generic Lessons Learned Described by Physicians Following a Diagnostic Error (Based on n = 254 Patient-Specific Lessons)
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